Oxygene ni kimwe mu bintu bikomeza ubuzima
Mitochondria ni ahantu h'ingenzi mu gukwirakwiza ibinyabuzima mu mubiri. Niba tissue ari hypoxic, inzira ya oxyde ya fosifora ya mitochondriya ntishobora gukomeza muburyo busanzwe. Nkigisubizo, guhindura ADP kuri ATP birabangamiwe kandi ingufu zidahagije zitangwa kugirango habeho iterambere risanzwe ryimikorere itandukanye.
Gutanga ogisijeni
Amaraso ya ogisijeni ya ArterialCaO2 = 1.39 * Hb * SaO2 + 0.003 * PaO2 (mmHg)
Ubushobozi bwo gutwara OxygeneDO2 = CO * CaO2
Igihe ntarengwa kubantu basanzwe bihanganira ifatwa ryubuhumekero
Mugihe uhumeka umwuka: 3.5min
Iyo uhumeka 40% ogisijeni: 5.0min
Iyo uhumeka 100% ogisijeni: 11min
Guhana gaze ibihaha
Umuvuduko wa ogisijeni mu kirere (PiO2): 21.2kpa (159mmHg)
Umuvuduko ukabije wa Oxygene mu ngirabuzimafatizo (PaO2): 13.0kpa (97.5mmHg)
Umuvuduko wamaraso uvanze igice cya ogisijeni (PvO2): 5.3kpa (39,75mmHg)
Umuvuduko wa ogisijeni uringaniye (PaO2): 12.7kpa (95.25mmHg)
Impamvu za hypoxemia cyangwa kubura ogisijeni
- Alveolar hypoventilation (A)
- Guhumeka / parufe (VA / Qc) Kutagereranya (a)
- Kugabanuka gutatanya (Aa)
- Kwiyongera kwamaraso kuva iburyo ujya ibumoso (Qs / Qt Yiyongereye)
- Hypoxia ya Atmospheric (I)
- Indwara ya hypoxia
- Indwara ya hypoxia
- Tissue toxic hypoxia
Imipaka ya physiologiya
Mubisanzwe abantu bemeza ko PaO2 ari 4.8KPa (36mmHg) niyo mipaka yumubiri wumuntu
Akaga ka hypoxia
- Ubwonko: Ibyangiritse bidasubirwaho bizabaho mugihe umwuka wa ogisijeni uhagaritswe muminota 4-5.
- Umutima: Umutima ukoresha ogisijeni kuruta ubwonko kandi niwo wumva cyane
- Sisitemu yo hagati yo hagati: Yumva neza, yihanganira nabi
- Guhumeka: Indwara y'ibihaha, bronchospasm, cor pulmonale
- Umwijima, impyiko, ibindi: Gusimbuza aside, hyperkalemia, kwiyongera kwamaraso
Ibimenyetso nibimenyetso bya hypoxia ikaze
- Sisitemu y'ubuhumekero: Guhumeka bigoye, kuribwa mu bihaha
- Imitsi yumutima: Palpitations, arththmia, angina, vasodilation, guhungabana
- Sisitemu yo hagati yo hagati: Euphoria, kubabara umutwe, kunanirwa, kubangamira imitekerereze, imyitwarire idakwiye, ubunebwe, guhagarika umutima, kuva amaraso menshi, guhungabana, koma.
- Imitsi yimitsi: Intege nke, guhinda umushyitsi, hyperreflexia, ataxia
- Metabolism: Kugumana amazi na sodium, aside
Impamyabumenyi ya hypoxemia
Ubwitonzi: Nta cyanose PaO2> 6.67KPa (50mmHg); SaO2 <90%
Ugereranije: Cyanotic PaO2 4-6.67KPa (30-50mmHg); SaO2 60-80%
Birakabije: Ikimenyetso cyanose PaO2 <4KPa (30mmHg); SaO2 <60%
PvO2 Umuvuduko ukabije wa ogisijeni wumuvuduko wigice
PvO2 irashobora kugereranya impuzandengo ya PO2 ya buri tissue kandi ikora nk'ikimenyetso cya hypoxia.
Agaciro gasanzwe ka PVO2: 39 ± 3.4mmHg.
<35mmHg tissue hypoxia.
Gupima PVO2, amaraso agomba gukurwa mumitsi yimitsi cyangwa atrium iburyo.
Ibimenyetso byo kuvura ogisijeni
Termo Ishihara gusaba PaO2 = 8Kp (60mmHg)
PaO2 <8Kp, Hagati ya 6.67-7.32Kp (50-55mmHg) Ibimenyetso byo kuvura ogisijeni igihe kirekire.
PaO2 = 7.3Kpa (55mmHg) Ubuvuzi bwa Oxygene burakenewe
Amabwiriza akomeye yo kuvura Oxygene
Ibimenyetso byemewe:
- Hypoxemia ikaze (PaO2 <60mmHg; SaO <90%)
- Umutima no guhumeka birahagarara
- Hypotension (Umuvuduko w'amaraso wa Systolike <90mmHg)
- Umusaruro muke wumutima hamwe na aside metabolike (HCO3 <18mmol / L)
- Guhangayikishwa n'ubuhumekero (R> 24 / min)
- Uburozi bwa CO
Kunanirwa mu myanya y'ubuhumekero no kuvura ogisijeni
Kunanirwa gukabije k'ubuhumekero: guhumeka umwuka wa ogisijeni utagenzuwe
ARDS: Koresha peep, witondere uburozi bwa ogisijeni
Uburozi bwa CO: ogisijeni ya hyperbaric
Kunanirwa k'ubuhumekero karande: kuvura ogisijeni
Amahame atatu yingenzi yo kuvura ogisijeni igenzurwa:
- Mugihe cyambere cyo guhumeka umwuka wa ogisijeni (icyumweru cya mbere), guhumeka umwuka wa ogisijeni <35%
- Mugihe cyambere cyo kuvura ogisijeni, guhumeka neza kumasaha 24
- Igihe cyo kuvura:> ibyumweru 3-4 → Guhumeka umwuka wa ogisijeni uhoraho (12-18h / d) * igice cyumwaka
Ubuvuzi bwa ogisijeni murugo
Hindura uburyo bwa PaO2 na PaCO2 mugihe cyo kuvura ogisijeni
Urwego rwo kwiyongera muri PaCO2 muminsi 1 kugeza 3 yambere yo kuvura ogisijeni ni intege nke zifitanye isano nimpinduka za PaO2 * 0.3-0.7.
PaCO2 munsi ya anesthesia ya CO2 ni 9.3KPa (70mmHg).
Ongera PaO2 kugeza 7.33KPa (55mmHg) mumasaha 2-3 nyuma yo guhumeka ogisijeni.
Igihe giciriritse (iminsi 7-21); PaCO2 igabanuka vuba, kandi PaO2 ↑ yerekana isano ikomeye.
Mugihe cyakurikiyeho (iminsi 22-28), PaO2 ↑ ntabwo ari ngombwa, kandi PaCO2 iragabanuka.
Isuzuma ry'ingaruka zo kuvura Oxygene
PaO2-PaCO2: 5.3-8KPa (40-60mmHg)
Ingaruka ziratangaje: Itandukaniro> 2.67KPa (20mmHg)
Ingaruka zo kuvura zishimishije: Itandukaniro ni 2-2.26KPa (15-20mmHg)
Ingaruka mbi: Itandukaniro <2KPa (16mmHg)
Gukurikirana no gucunga imiti ya ogisijeni
- Itegereze gaze yamaraso, ubwenge, imbaraga, cyanose, guhumeka, umuvuduko wumutima, umuvuduko wamaraso hamwe no gukorora.
- Oxygene igomba guhinduka kandi igashyuha.
- Reba catheters n'inzitizi zamazuru mbere yo guhumeka ogisijeni.
- Nyuma yo guhumeka kabiri kwa ogisijeni, ibikoresho byo guhumeka umwuka wa ogisijeni bigomba gusuzumwa no kwanduzwa.
- Kugenzura metero ya ogisijeni buri gihe, kwanduza icupa ry’amazi kandi uhindure amazi buri munsi. Urwego rwamazi rugera kuri 10cm.
- Nibyiza kugira icupa ryinshi kandi ukagumana ubushyuhe bwamazi kuri dogere 70-80.
Ibyiza n'ibibi
Urumogi rwamazuru hamwe no kuzunguruka kwizuru
- Ibyiza: byoroshye, byoroshye; ntabwo bigira ingaruka ku barwayi, gukorora, kurya.
- Ibibi: Kwibanda ntabwo bihoraho, byoroshye guhumeka; mucous membrane irritation.
Mask
- Ibyiza: Kwibandaho birasa neza kandi hariho imbaraga nke.
- Ibibi: Bigira ingaruka kubitekerezo no kurya kurwego runaka.
Ibimenyetso byo gukuramo ogisijeni
- Kumva ufite ubwenge kandi ukumva umerewe neza
- Cyanose irazimira
- PaO2> 8KPa (60mmHg), PaO2 ntigabanuka nyuma yiminsi 3 nyuma yo gukuramo ogisijeni
- Paco2 <6.67kPa (50mmHg)
- Guhumeka biroroshye
- HR itinda, arththmia iratera imbere, kandi BP iba ibisanzwe. Mbere yo gukuramo umwuka wa ogisijeni, guhumeka umwuka wa ogisijeni bigomba guhagarikwa (amasaha 12-18 / kumunsi) iminsi 7-8 kugirango harebwe impinduka ziterwa na gaze.
Ibimenyetso byo kuvura ogisijeni igihe kirekire
- PaO2 <7.32KPa (55mmHg) / PvO2 <4.66KPa (55mmHg), imiterere irahagaze, kandi gaze yamaraso, uburemere, na FEV1 ntabwo byahindutse cyane mugihe cyibyumweru bitatu.
- Bronchite idakira na emphysema hamwe na FEV2 munsi ya litiro 1,2
- Indwara ya hypoxemia nijoro cyangwa syndrome ya apnea
- Abantu bafite imyitozo iterwa na hypoxemia cyangwa COPD mugukiza bashaka gukora urugendo rurerure
Umuti muremure wa ogisijeni urimo umwuka uhoraho wa ogisijeni mumezi atandatu kugeza kumyaka itatu
Ingaruka mbi no gukumira imiti ya ogisijeni
- Uburozi bwa Oxygene: Ubwinshi bwo guhumeka umwuka wa ogisijeni ni 40%. Uburozi bwa Oxygene bushobora kubaho nyuma yo kurenga 50% mu masaha 48. Kwirinda: Irinde guhumeka umwuka mwiza wa ogisijeni mu gihe kirekire.
- Atelectasis: Kwirinda: Igenzura ubukana bwa ogisijeni, ushishikarize guhindukira kenshi, uhindure imyanya yumubiri, kandi uteze imbere gusohora.
- Amasohoro yubuhumekero yumye: Kwirinda: Shimangira ubuhehere bwa gaze ihumeka kandi ukore umwuka wa aerosol buri gihe.
- Inyuma ya lens fibrous tissue hyperplasia: igaragara gusa kubana bavutse, cyane cyane impinja zitaragera. Kwirinda: Komeza umwuka wa ogisijeni uri munsi ya 40% kandi ugenzure PaO2 kuri 13.3-16.3KPa.
- Kwiheba k'ubuhumekero: bigaragara ku barwayi bafite hypoxemia no kugumana CO2 nyuma yo guhumeka umwuka wa ogisijeni mwinshi. Kwirinda: Gukomeza okisijeni ikomeza gutemba.
Ubusinzi bwa Oxygene
Igitekerezo: Ingaruka z'ubumara ku ngirabuzimafatizo zatewe no guhumeka umwuka wa ogisijeni ku gipimo cya 0.5 cy'ikirere cyitwa ubumara bwa ogisijeni.
Kuba ubumara bwa ogisijeni buterwa nigitutu cyigice cya ogisijeni aho kuba ogisijeni yibanze
Ubwoko bwa Oxygene
Uburozi bwa ogisijeni
Impamvu: Uhumeka ogisijeni hafi yikirere kimwe cyumuvuduko wamasaha 8
Kugaragara kwa Clinical: ububabare bwinyuma, inkorora, dyspnea, kugabanya imbaraga zingenzi, no kugabanuka kwa PaO2. Ibihaha byerekana ibikomere, hamwe no kwanduza ingirabuzimafatizo, ubwinshi, kuribwa na atelectasis.
Kwirinda no kuvura: kugenzura kwibanda hamwe nigihe cyo guhumeka ogisijeni
Ubumara bwa ogisijeni yo mu bwonko
Impamvu: Guhumeka ogisijeni hejuru yikirere 2-3
Kugaragara kwa Clinical: kutabona neza no kutumva, isesemi, guhungabana, gucika intege nibindi bimenyetso byubwonko. Mu bihe bikomeye, koma n'urupfu birashobora kubaho.
Igihe cyo kohereza: Ukuboza-12-2024